Avoiding propofol injection pain in children: A prospective, randomized, double-blinded, placebo-controlled study

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Abstract

Background: Pain on injection limits the use of propofol in children. The combination of lidocaine and propofol is widely used to reduce pain. A new solvent [medium-chain triglyceride (mct)/long-chain triglyceride (lct)] has been advocated to be less painful than standard (lct) propofol in adults, but no information is available of its usefulness in pre-school children. We designed a prospective, randomized, double-blinded, placebo-controlled study to assess injection pain with two different propofol emulsions, each given with or without lidocaine in children <7 yr. Methods: A total of 160 ASA I-III children were randomly assigned to receive lct-propofol or mct/lct-propofol, 5 mg kg -1, with lidocaine 10 mg ml-1 or saline. The site and size of venous cannulation and restlessness before injection were recorded in each patient. A pain score graded 0-6 was established based on spontaneous verbal and motor reaction during injection, each graded 0-3. Kruskall-Wallis and Mann-Whitney tests were used for statistical analysis. Results: Median pain scores decreased in all groups compared with lct-propofol-saline (P<0.001) and were least in the lct/mct-propofol-lidocaine group (P<0.001). Painless injection (score, 0-2) occurred in 92.5% of patients in the mct/lct-propofol- lidocaine group compared with 41-77% in the others (P<0.001). Conclusions: Mct/lct-propofol caused significantly less pain than lct-propofol in preschool children. Mixing of lidocaine with mct/lct-propofol resulted in a further significant decrease, virtually eliminating the pain on injection. © The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved.

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Rochette, A., Hocquet, A. F., Dadure, C., Boufroukh, D., Raux, O., Lubrano, J. F., … Capdevila, X. (2008). Avoiding propofol injection pain in children: A prospective, randomized, double-blinded, placebo-controlled study. British Journal of Anaesthesia, 101(3), 390–394. https://doi.org/10.1093/bja/aen169

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